Training non-neurologists to diagnose epilepsy

PURPOSE Narrowing the epilepsy treatment gap in the world's poorest countries is one of the greatest challenges that the epilepsy community faces. The reliable diagnosis of epilepsy is the first step in this. In well-off countries, doctors, often neurologists, carry this out but this is unrealistic in the developing world where there are often no neurologists, particularly in the rural areas where most people live. Other health professionals therefore need to acquire the skills to diagnose epilepsy. METHOD A trainee doctor and a nurse accompanied an experienced neurologist on epilepsy camps in Nepal. Answers to a defined set of about 50 questions were obtained from each patient. The two participants made the diagnosis, of epilepsy or not epilepsy, independently of each other and of the neurologist. Their diagnoses were then compared with those of the neurologist who then explained the reasons for his diagnosis. RESULTS Agreement between each participant and the neurologist increased from about 50% at the start to over 90% after 20 patients. In one of the participants a high level of agreement was maintained 12 months later. CONCLUSION It is possible to train non-neurologists to diagnose epilepsy like a neurologist after exposure to only 20 patients in the company of that neurologist. This is a way in which experienced neurologists can help narrow the treatment gap in poorer parts of the world.